Abstract
Persistent or severe hemorrhagic radiation proctitis (HRP) has limited therapeutic options.
To describe our experience with ozone therapy (O3T) in the management of refractory HRP.
Patients (n=17; median age 69 years [range 42–80 years]) previously irradiated for prostate or uterine cancer and suffering persistent or severe HRP without response to conventional treatment were enrolled to receive an O3/O2 gas mixture via rectal insufflations and topical application of ozonized oil. Most of the patients (83%) had Grade 3 or Grade 4 toxicity. Median follow-up post-O3T was 40 months (range 3–56 months).
Endoscopic treatments required were: 43 (median 1; range 0–10) pre-O3T; 17 (median 0; range 0–8; P=0.063) during O3T; and five (median 0; range 0–2; P=0.008) during follow-up. Hemoglobin levels were 10.35g/dL (7–14g/dL) pre-O3T and 13g/dL (9–15g/dL) (P=0.001) post-O3T. Median toxicity grades were 3 (range 2–4) pre-O3T, 1 (range 0–2; P<0.001) at the end of O3T, and 0 (range 0–1; P<0.001) at the last follow-up.
Persistent advanced HRP was significantly improved with O3T. The addition of O3T can be useful as a complementary treatment in the long-term management of HRP and, as such, merits further evaluation.